Patients’ Perceived Level of Clinician Knowledge of Transgender Health Care, Self-rated Health, and Psychological Distress Among Transgender Adults
Authors: Gabe H. Miller, Guadalupe Marquez-Velarde, Alex R. Mills, Stephanie M. Hernandez, Lauren E. Brown, Mudasir Mustafa, Jesse E. Shircliff
Journal: JAMA Network Open (2023)

Importance Transgender, gender nonbinary, and genderqueer people are at increased risk for negative health outcomes, and medical school education is currently lacking on inclusion of these topics. However, there is little evidence of an association of clinician knowledge with the health of transgender people. Objective To evaluate the associations of patients’ perceptions of clinician knowledge with self-rated health and severe psychological distress among transgender people. Design, Setting, and Participants In this cross-sectional study, a secondary data analysis of the 2015 US Transgender Survey (a survey of transgender, gender nonbinary, and genderqueer adults conducted across 50 states) Washington, DC, US territories, and US military bases in 2015 was performed. Data were analyzed from February to November 2022. Exposures Patients’ perception of their clinician’s knowledge about transgender health care. Main Outcomes and Measures Self-rated health, dichotomized as poor or fair vs excellent, very good, or good, and severe psychological distress (scoring a validated threshold of ≥13 on the Kessler Psychological Distress Scale). Results The sample included a total of 27 715 respondents (9238 transgender women [33.3%; 55.1% weighted; 95% CI, 53.4%-56.7%], 22 658 non-Hispanic White individuals [81.8%; 65.6% weighted; 95% CI, 63.7%-67.5%], and 4085 individuals aged 45-64 years [14.7%; 33.8% weighted; 95% CI, 32.0%-35.5%]). Of 23 318 individuals who answered questions regarding their perceptions of their clinicians’ level of knowledge, 5732 (24.6%) reported their clinician knows almost everything about transgender care, 4083 (17.5%) reported their clinician knows most things, 3446 (14.8%) reported their clinician knows some things, 2680 (11.5%) reported their clinician knows almost nothing, and 7337 (31.5%) reported they were unsure. Nearly 1 in 4 transgender adults (5612 of 23 557 individuals [23.8%]) reported having to teach their clinician about transgender people. In total, 3955 respondents (19.4%; 20.8% weighted; 95% CI, 19.2%-22.6%) reported fair or poor self-rated health and 7392 (36.9%; 28.4% weighted, 95% CI, 26.9%-30.1%) met the criteria for severe psychological distress. After adjusting for covariates, compared with individuals who reported their clinician knows almost everything about transgender care, exposure to clinicians with lower perceived levels of knowledge about transgender care was associated with significantly higher odds of fair or poor self-rated health (adjusted odds ratio [aOR] for knowing almost nothing, 2.63; 95% CI, 1.76-3.94; aOR for unsure, 1.81; 95% CI, 1.28-2.56) and severe psychological distress (aOR for knowing almost nothing, 2.33; 95% CI, 1.61-3.37; aOR for unsure, 1.37; 95% CI, 1.05-1.79). Respondents who had to teach a clinician about transgender people had higher odds of reporting fair or poor self-rated health (aOR, 1.67; 95% CI, 1.31-2.13) and severe psychological distress (aOR, 1.49; 95% CI, 1.21-1.83) compared with those who did not. Conclusion and Relevance The findings of this cross-sectional study suggest that there is an association between perceived clinician knowledge about transgender people and self-rated health and psychological distress among transgender people. These results highlight the importance of integration and enhancement of transgender health in medical education curriculum as a necessary intervention to improve the health of transgender people.